Introduction: Over 100 procedures for repair of rectal prolapse have been described. They are broadly classified into abdominal and perineal repairs. We would like to present our experience of perineal rectosigmoidectomy with stapled coloanal anastomosis for rectal prolapse.

Methods: This video depicts an 82 year old female patient with a 10 year history of rectal prolapse. Physical exam confirmed circumferential full thickness rectal prolapse and, accordingly, she was scheduled for perineal rectosigmoidectomy. Under general endotracheal anesthesia, she was positioned prone-jacknife. The anus was effaced with a Lone-Star retractor? (Lone Star Medical Products (ProductId, DateEntered, Title, Authors, Description, LengthInMinutes, YearProduced, Category, SubCategory, SubSubCategory, Association, MediaFormats, Price, MemberPrice), Inc, Stafford, Texas) and the submucosa was infiltrated with a solution of 0.5% Xylocaine with 0.25% Marcaine with 1:400,000 units of epinephrine. A circumferential incision was made 2 cm to the dentate line. 55 cm of redundant rectosigmoid were resected. A purse string was placed on the descending colon using a clamp, and a hand-sewn purse string was placed on the cut edge of the anoderm. A 33-mm circular stapler was passed through the anus and a stapled coloanal anastamosis was performed. The proximal and distal tissue donuts were confirmed as circumferentially intact and full thickness. Hemostasis was verified, and inspection confirmed a healthy, intact anastamosis.

Results: Patient tolerated surgery well.

Conclusion: Perineal rectosigmoidectomy with stapled coloanal anastomosis for rectal prolapse is feasible and can be recommended for rectal prolapse repair in selected patients.